Effective patient-provider communication is recognized in Healthy People 2010 as a vital element of good health care. For some patients, a positive relationship conveyed in patient-provider communication is the most therapeutic aspect of a health visit. The purpose of this study is to examine how nurse practitioners (NPs) communicate positive relationships to older, ethnically diverse patients in managed and non-managed care settings during scheduled visits and the patient outcomes associated with that communication. Hypotheses focus on testing whether activity coordination between older patients and NPs mediates their relational communication and whether their relational communication mediates patient outcomes. The long-term objective of the research is to create nursing interventions for the strategic use of communication to improve older patients' health. A predictive correlational design will be used in which each of 30 NPs will interact with a number of different older patients for a total of 150 encounters. Patients will be European-American and African-American men and women age 65 or older. NPs will be European-American and African-American women. Prior to the encounters, which will be videotaped, questionnaires will be used to obtain data about the structural characteristics of the clinical setting and patients' and NPs' personal characteristics. Following the encounters, questionnaires will be used to obtain data regarding patients' perceptions of the relational themes communicated by the NPs, satisfaction with the NPs' communication, recall of the recommended plan of care, and intention to adhere to the plan. Four weeks later, questionnaires will be read to patients by telephone to obtain data about adherence to the plan and health status. The nonverbal activities observed in two segments of each videotaped health encounter will be coded, and the extent of older patient-NP activity coordination will be calculated. Verbal activities will be coded for the entire recorded length of each encounter. Based on repeated measures multiple regression analyses of the best subsets of structural characteristics, personal characteristics, communication patterns, and patient outcomes, the hypotheses will be tested. The increasing number of older patients, the complex nature of their health care needs, and the likelihood that they will be cared for by NPs underscores the need for and understanding of effective older patient-NP communication. By examining this communication within a complete, complex model using a multidimensional approach, the study will make a contribution to effective patient-provider communication and thus to good health care for a large segment of the population.